GENERAL
Giardia were first discovered by Professor of Kharkov University D.F.Lyamblem in the middle of the XIX century in the faeces of children with diarrheas. The habitat of these protozoa in humans is small intestine, most often the duodenum.
The greatest number of reported cases of giardiasis falls on Asian and Latin American countries, although pathogen infection is widespread. Causes of chronic giardiasis in children and adults, and the optimal conditions for its development - a moderate temperature and the presence of stagnant freshwater.
When injected into the gastrointestinal tract giardia after reaching the small intestine begin active reproduction. With its arsenal of special suction cups, they attach to the villi of the mucous membranes of the digestive tract. This has a negative effect on fat absorption, membrane digestion and metabolism in general. Too active reproduction of parasitic microorganisms can cause irritation, which manifests pain in the upper abdomen, the navel and various diarrheal disorders - vomiting, rumbling, nausea, swelling. Also occur constipation alternating with attenuation chair, stool may have impurities mucus. Giardiasis can be expressed as the symptoms and occur unnoticed.
Chronic giardiasis in children and adults has a fecal-oral mechanism of transmission.
transmission path:
foodIn which infection occurs in the use of heat-treated foods.
Contact-household - characteristic of the pre-school institutions. Shatters the simplest household items, furniture surfaces or hands and when failure to comply with hygiene rules to enter the body.
Water - cysts of the pathogen in the water, in the use of which fall into the digestive tract. This is the most common route of transmission. Most often it is implemented in areas with natural springs or wells. Using household filters for water treatment is not always effective, since the size of cysts pathogen smaller than the pores of the sorbents in the device.
According to statistics, giardiasis often infected children under 10 years because of their active lifestyle and ignoring the rules of personal hygiene.
Factors that may contribute to the development of infection:
- low concentration of hydrochloric acid in the stomach;
- reduction of protein intake;
- the use of increased amounts of sucrose;
- defects of the immune system.
Symptoms of giardiasis often observed in children of workers and psychiatric institutions, professionals working in the cesspool or irrigation services.
CAUSES
Cause of infection is the simplest - Lambliaintestinalis. The microorganism can exist in two forms:
- autonomic;
- cystic.
Signs hronicheskogolyamblioza vegetative form:
- large cell;
- you can move using flagella;
- in front of the suction cup has a disc through which is fixed to the intestinal epithelial cells.
For cysts are characterized by:
- dense shell resistant to environmental conditions;
- 2 or core 4, depending on the degree of maturity;
- oval shape.
After contact cyst in the human intestine are two vegetative forms, the ability to move. They leave the skin cysts and attach to epithelial cells via prisasyvatelnogo disk.
Giardia cause mechanical damage to the intestinal wall, thus breaking the membrane digestion.
Multiple microtrauma cause irritation of the nerve endings to the formation of a painful syndrome. Violation of digestion promotes development of pathogenic organisms - there is dysbiosis. Also significantly reduces the absorption of almost all nutrients. life and dying just a product has a significant sensitizing effect, which manifests the development of allergic reactions.
CLASSIFICATION
The World Health Organization identifies chronic giardiasis in adults:
- latent form;
- symptomatic forms;
- intestinal forms;
- hepatobiliary form.
Symptoms in women and men and the nature of the infection:
- acute;
- chronic.
Latent Form asymptomatic, is the most common and is detected in 75% of patients infested.
Symptoms in Women and Men
Giardiasis clinical picture depends on the form of the disease. Let us consider each of these in detail.
Symptomatic form
Infection begins acutely, with periods of exacerbation, continuing 5-7 days, and subsided. The patient on the background of general malaise appears dominant symptom of giardiasis:
Gastrointestinal giardiasis - evident defeat of the digestive tract. The patient complains of pain in the abdomen uncertain localization and not related to food intake, impaired physiological functions, there is bloating, nausea, heartburn and other symptoms of diarrheal disorders.
intoxication syndrome depends on massive infestation, the severity and duration of the infection. It is characterized by the appearance of pruritus and neurological symptoms (fatigue, decreased performance, mood swings).
Allergy syndrome is accompanied by a change in color of the skin and the appearance of flaking. In addition, patients may be maculopapular rash, urticaria, or character. Emphasis is placed on a white coating and deep creases on language.
In women, symptoms lyambliozaklinicheskoy form - is the loss of body weight and the development of degenerative conditions in patients.
intestinal form
This form of infection can occur in the form of a variety of inflammatory diseases intestine. The main symptoms of giardiasis in vzroslyhmozhno considered:
- pain around the navel;
- multiple watery stools;
- bloating and rumbling in the abdomen;
- a feeling of heaviness in the stomach.
Of giardiasis symptoms, in addition to the symptoms of dyspepsia and abdominal pain in these patients should be mentioned violation of the general state of health, appearance of headaches and insomnia.
Hepatobiliary form of the disease
Gepatobiliarnyylyambioz manifested symptoms that resemble dyskinesia biliary tract and inflammatory pathology of the biliary system. With the progression of infection giardiasis joined symptoms of the pancreas to the development of dyspeptic disorders. Patient concerned:
- monotonous pain in the upper abdomen;
- diarrhea;
- weight loss.
DIAGNOSTICS
Diagnostic event at giardiasis:
- laboratory diagnostics;
- instrumental methods.
Laboratory diagnosis:
Parasitological method is the key to the definitive diagnosis. Detection of mature forms in the portions of duodenal contents or cystic forms in smears feces indicates giardiasis. It is worth remembering that in chronic infections or cysts are allocated periodically, so feces study should be carried out several times during the month.
Serological methods allow to determine the presence of antibodies to the pathogen or antigens directly lamblia. The most sensitive method is the immunofluorescence assay.
The general analysis of blood observed changes characteristic of inflammation: increased erythrocyte sedimentation rate, leukocytosis with the change in the formula of white blood cells. Possible reduction of hemoglobin content.
CBC has no specific symptoms.
Instrumental methods of diagnosis:
- Ultrasonography abdominal organs to determine the violation of muscle tone of the sphincter of the gallbladder, symptoms of shortness of the outflow of bile, signs of inflammation in the biliary system or pancreas iron.
- conduct fibrogastroduodenoscopy with the further study of duodenal contents is a reliable method of diagnosis of giardiasis. This method is carried out with a negative result of parasitological analysis and the presence of typical clinical picture of infection.
TREATMENT
When giardiasis in any case should not start treatment measures the appointment of antiparasitic drugs, as mass destruction just can cause severe poisoning of the body's own toxins and provoke the development of allergic reactions. To start for the first two weeks you need to use medication to reduce intoxication, Improving enzymatic function of the intestine, correction of local and general immunity. At this time, we should also stick to a diet, eat foods that prevent comfortable existence and development of bacteria (vegetables, cereal, dried fruit, vegetable oil), use cholagogue preparations, antihistamine drugs and sorbents to reduce consumption carbohydrates.
The next step is receiving antiparasitic medical devices - tiberal, triholopa, enterosorbents and drugihspetsificheskih drugs acting directly on the pathogen, and non-specific therapy aimed at improving the basic functions body. It is also necessary to take into account the expressed symptom of giardiasis in women, men and children.
Last mandatory item - conducting restorative measuresAmong which reception motility-enhancing foods (fermented milk products, vegetables, fruit puree, apple, etc.). It is also recommended to take a course receiving probiotics and multivitamins to restore normal intestinal microflora, its natural resistance to infection.
specific therapy
When giardiasis drugs for the first course of antiparasitic therapy are nitroimidazoles. Such substances are shown only for laboratory-proven giardiasis.
Application of antiparasitic drugs allows to destroy the pathogen giardiasis effectively, however, provoke mass mortalities lamblia amplification allergic reactions.
Therefore, this therapy is carried out under the cover of non-specific methods of treatment of infection.
Non-specific treatment:
Diet for giardiasis should contain those foods that worsen the conditions for the reproduction of protozoa. Therefore, in the diet reduce the amount of simple carbohydrates and added to dishes, improve peristalsis and performing the function of sorbent.
Drugs that improve the rheological properties of bile and its flow from the gallbladder into the duodenum. Due to this reduced stagnation in the biliary system, and decreases the activity of the inflammatory process.
antispasmodics can reduce the tone of the sphincter of the gall bladder and improve the flow of bile.
hepatoprotectors It allows you to restore the structure of the liver cells, which helps to improve the functional activity of the body.
chelators reducing the concentration of toxic substances, and their effect on the body tissue.
Antihistamine drugs reduce the intensity of allergic reactions in the destruction of pathogens.
Dispensary observation of patients after the treatment is carried out during the year.
COMPLICATIONS
For giardiasis, as a rule, passes without complications. However, toxic shock can occur when a massive invasion. With long-term chronic infectious process may develop anemia associated with malabsorption of vitamins.
PREVENTION
The main preventive measures:
- personal hygiene;
- boiling the water before use;
- conduct regular inspections in kindergartens;
- mechanical destruction vectors lamblia (flies, cockroaches);
sanitary and educational work among the population - in the first place, it should be conducted in groups risk, which also includes persons visiting areas endemic for various parasitic diseases.
To prevent the spread of giardiasis and the faces of the food enterprises, draws on the work should take place protozoologicheskoe survey. In case of deterioration of the intestinal infection in the enterprise complex clinical diagnostic measures should also replenish protozoologicheskim study. Identified carriers of Giardia and healthy tsistovydeliteli sanitize or treated.
FORECAST FOR RECOVERY
The prognosis for giardiasis favorable. Giardiasis often has a chronic course, but carrying out adequate therapy facilitates complete freedom from pathogens.
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